Spirit of Christmas - Part 1
by Melissa Rivers
Summary: My first ER fic. It's almost Christmas and a few surprises abound in the ER.


SPIRIT OF CHRISTMAS   
by Missy  
(missy@lexicon.net)   
  
AUTHOR'S NOTES:  
  
This story was put together just after the episode of 'Exodus' although it  
has been adapted to allow for some of the events which took place in  
subsequent episodes to the end of Season Four. All of the medical  
dramas were written directly after Exodus. I know there are a couple of  
ideas which are similar to following eps. I debated on removing them  
but they will be needed at a later stage. So forgive me for those. It is  
also written in an episodic style.  
  
It is set two nights prior to Christmas 1998 and the ER Department is  
still awaiting the appointment of a new Chief of Emergency Services. In  
the meantime, Dr. Kerry Weaver has continued in the position of Acting  
Chief. Dr. Elizabeth Corday has a new sponsor, namely Dr. Mark  
Greene (don't ask me to explain this - just an idea) and Dr. Doug Ross  
has been appointed Pediatric Attending on the basis that he obtains his  
Board Certification in Emergency Medicine.   
  
Characters appearing that you know: Dr. Mark Greene, Dr. Kerry  
Weaver, Dr. Doug Ross, Dr. Elizabeth Corday, Dr. Anna Del Amico, Dr.  
John Carter, Dr. Peter Benton, Dr. Maggie Doyle, Jeanie Boulet, Carol  
Hathaway, Haleh Adams, Conni Oligiario, Malik McGrath, Yoshi, Lily,  
Lydia Wright, Jerry Markovic, Randi Franzacki,   
  
DISCLAIMER:  
These are the property of Michael Crichton, Warner Bros, Constant   
Productions and Amblin Television and to the actors who so marvellously  
portray them.   
  
The following characters have been added for my own benefit: Dr.  
Ashlea Waters, Intern, Dr. Samuel Cheung, Chief Resident, Vikash  
Randivara, Medical Student, Kate McPherson, Physician's Assistant,  
Meredith Chandler and Amara Ngaru, Registered Nurses.  
  
Description of procedures and medications have been obtained from  
"The medicine of ER" by Drs. A. D. Ross & H. Gibbs, Blacks Medical  
Dictionary, Johns Hopkins Medical Manual, Medico-Legal Dictionary  
and the CDC, Atlanta USA. Any errors are my own interpretations.  
  
Now with all the legals over, here it is and I hope you like it.  
  
PART 1/?  
  
Chaos reigned in the Emergency Room Department of County General  
Hospital at late afternoon. Blizzard conditions over the past couple of  
days had resulted in an increase in out-patients. Snow continued to fall  
as a child cried, while the TV blared out its news coverage on the  
weather pattern. A frazzled mother tried to calm the screaming baby as  
her two older children raced each other around the chairs and over the  
feet of other waiting patients. Another middle aged woman moaned  
about her pains and the time being taken to see her. An elderly man,  
clearly showing signs of intoxication, belted out his slurred discordant  
rendition of 'Moon River' over the cacophony.  
  
With Christmas in two days, decorations adorned the walls and waiting  
area of the ER. One of the many food poisoning cases suddenly was  
overwhelmed by the pain and left the contents of his stomach on Lydia's  
shoes just as she walked past. Grimacing, she called out to Malik at the  
nurses station to call housekeeping to clean up the mess while she went  
to clean her shoes.  
  
"Carol, these are the last three food poisoning cases to be treated and  
hopefully that's it. We've had no further admits in the last hour."   
Haleh commented to Carol who was just beginning her evening shift,  
handing her the charts. "Weaver's allocated them to Carter and Anna  
and she'll be the attending."  
  
Dr. Kerry Weaver came to the administration desk, a completed chart in  
hand dropping it into the holder for completed cases to be made into  
official files.   
  
"Jerry, contact pharmacy and find out what's happened to the stock  
orders" she requested as she went across and cleared the patient's name  
from the admittance board. It would not be long before another patient's  
name filled the gap. At this time of year the admit board was always full  
and a full moon seemed to have only increased the workload.  
  
Jerry, on the phone to the labs chasing up blood work, nodded in  
acknowledgement of the request.   
  
"Busy day?" Carol asked.  
  
"Twenty-five cases of food poisoning" Lily commented as she went  
across to Kerry to have the case signed off by her as attending physician.  
  
"Nope, twenty-eight." Haleh corrected as she indicated to the final three  
charts.   
  
Jerry finished his call and dialled pharmacy. Finding a box of Yum Cha  
selections on the desk, he selected an pork roll.  
  
"I wouldn't be eating that unless you want to join the other food  
poisoning cases. " Kerry commented as she passed by Carol, collecting  
the three charts from her.  
  
Jerry's hand holding the roll froze, his mouth wide open ready to eat the  
tasty morsel. Mortified, he looked twice at the offending roll, debating  
whether to risk it, before tossing it back into the container and dumping  
the entire contents into the trash in disgust.  
  
Carter came through minus his bouncy step, his face decidedly free  
from his usual grin after having to treat an unusual proportion of food  
poisoning cases, several charts in his hand, grateful to be able to have  
them signed off as completed.   
  
"Carter, Weaver's got the last of the cases in Exam 4. I think she's  
waiting for you." Lily advised with a grin.  
  
Dropping the charts in her hands, he gave a pained look before heading  
to Exam 4 as he was directed.  
  
"Help me, please" cried a distressed woman as she rushed through the  
emergency room doors carrying a young boy. He was in obvious  
respiratory distress. "He's having an asthma attack."  
  
Carol came around to the mother, taking the child from his mother's  
arms as she quickly took charge, placing him on a gurney.   
  
"Jerry, call Doug immediately to Exam One." Carol called out as she  
and Lily pushed the trolley to Exam Room 1. Jerry handed over a  
clipboard with the usual forms to Lily as she went past and sending a  
passing med student to get Dr. Ross to Exam Room 1 stat.  
  
As the trolley was wheeled into the exam room, they put it into a sitting  
position to help the boy breath easier, immediately grabbing the oxygen  
mask to assist him with his breathing.   
  
"What's his name?" Carol asked.  
  
"David, David Collins" Mrs. Collins replied her voice choked with  
suppressed tears, distressed by her son's condition.  
  
Lily connected the pulse ox monitor while Carol placed her stethoscope  
on the boy's back.  
  
"David, I want you to take a deep breath in and then out when I say so,  
okay." Carol said gently.   
The small boy nodded his head, still struggling to breathe, obviously  
frightened but willing to trust Carol who seemed to be controlled and  
calm as opposed to his frantic mother.  
  
"Okay, now breathe in" There was a brief pause before she continued  
"And out." As she listened, she could hear the congestion he was  
having with his expiration of the air.   
  
"What medication is he on?" Carol asked.  
  
At that moment, Doug Ross came through the door followed closely by  
Ashlea Waters, an intern.  
  
"Ventolin morning and night by nebuliser." Mrs. Collins answered  
quickly, pulling out a note from her bag which set out his medications  
and handed it over to Carol.  
  
Carol gave him a quick rundown of the case and he checked David's  
breathing also.  
  
"Resps 35, Pulse 145, Pulse Ox is down to 88." Lily reported.  
  
"Is he on any other medication?" Doug queried after consulting the list.  
  
"No" she replied shaking her head.  
  
"Okay. Give him 5 mics per minute prednisolone IV infusion and an  
amp of salbutamol by mask." Doug instructed writing out the meds on  
the chart and signing it off.  
  
Ashlea inserted the IV into David's arm talking to him gently as she did  
so. Lily passed her the dose of presnisolone which she injected as Carol  
prepared the nebuliser affixing it to the oxygen mask, placing it back  
over his mouth and nose.  
  
"It won't be long before your feeling better." Doug said as he touched the  
boy on his arm, giving him reassurance with a gentle smile. "Ashlea,   
keep a close eye on him. In fifteen minutes, check his volume."  
  
"Mrs. Collins could you come with me to complete the rest of the  
forms." Carol firmly guided her towards the admit area, accompanied by  
Doug, and left her in the admit area with Jerry.  
  
At the nurses desk, Doug slipped his arms around her waist, resting his  
head on her shoulder, murmuring to her. "So how many have we got  
coming tomorrow night?"  
  
"Would you believe that everyone is coming with the exception of my  
mother." Carol replied.  
  
"What's wrong that she won't come. She normally loves Christmas  
celebrations. Did you include Havier on the invitation? I think she  
would be disappointed to miss this year's one and we would never hear  
the end of it." Doug said with a knowing smile.  
  
Carol turned around to face him, her face puckered with worry. "Yes I  
did. Do you think we should tell her?"  
  
Slipping his arms back around her waist, he reassured her. "Give her a  
call and see if she's coming. If she says no, then tell her. But don't let  
her say anything to anyone else."  
  
Carter returned to the nurses desk, still laden with charts. Doug released  
Carol and she sat down in the chair, pulling out some management  
documents she needed to complete.  
  
"What did you do to get on Kerry's wrong side?" Doug commented,  
indicating to Carter's handful of charts of scut work combined with the  
food poisoning cases.  
  
"Three med students are out with the 'flu" he replied. "I hear a rumour  
that the Chief of Emergency Services is to be appointed today."  
  
"Yeah. I'd heard it to but I'd be surprised if it is. It's already after four  
o'clock. They would have announced it by now. The odds have been in  
Weaver's favour." Doug referred to the sweepstakes that was often  
placed on who was getting these positions.   
  
"Did Mark apply?"   
  
"What's all this whispering in the corner, guys?" Mark asked as he  
logged in on the computer.   
"Have you heard anything about the Chief of Emergency Services being  
appointed today?" Doug asked.  
  
Carol decided to leave them to have their discussion. Having attained  
equal footing with Kerry and Mark, Doug was loath to be insubordinate  
to Kerry once again and she knew he would be scrounging for any news  
about the appointment of the new Chief.  
  
"Uh, yeah." Mark commented shortly, now wanting to cut the  
conversation short.   
  
"So, is it Weaver?" Carter injected.  
  
"Anspaugh will be down within the hour to announce the position."  
  
"And you're not going to let on who it is." Doug stated.  
  
"Doug, you know my position." Mark retrieved the information he  
needed from the computer, jotting it down on the chart. "Look, you will  
all know soon."   
  
"He doesn't seem to happy about the appointment?" Carter asked  
watching the retreating figure.  
  
"No. I wonder what it is all about?" Doug's brow furrowed as he  
thought about it a moment, before deciding he had better get on with  
seeing his patients going to the admissions board to find his next patient.   
Carter followed and gave Randi some of his charts to chase up the labs  
he was waiting on.  
  
The radio beeped before a distorted voice came over the air "County  
General over"  
  
"Loud and clear over" responded Carol, the line crackling as she released  
the button on the side.  
  
"Two hit and run victims with head, chest and leg trauma. Aged 6 and 5  
years, ETA two minutes." The information was brief and to the point  
preparing the staff for the urgent treatment of the victims.  
  
"Over" Carol finished the call.   
  
Carol came over to where Doug had just collected another file.  
  
"Doug, six and five year old hit and run victims with head chest and leg  
trauma. ETA two minutes." Carol relayed.  
  
"Okay, call Mark and Kerry and get the Trauma Rooms ready. Stat."   
Doug responded. Turning to Carter, he directed "Call for a surgical  
consult and find Anna."   
  
A flurry of controlled activity took place as staff quickly made sure that  
everything was in order and ready for the emergency arrivals to give the  
victims the best chance of survival.  
  
Sirens heralded the arrival of the ambulance, flashing lights bathing the  
waiting area in a kaleidoscope of blue and red. Doug, Carter and Haleh  
met the paramedics as they came crashing through the ER doors, rushing  
alongside. Doug immediately took over the control of the ambu-bag as  
the paramedic spurted the current state of the injured boy.   
  
"Six year old boy, head and chest trauma. Last BP was 90 over 60.   
Pulse 60. Diminished lung sound on the right. GCS 3-3-5."  
  
The gurney was quickly moved through the jumble of the waiting area,  
down to Trauma One. Mark followed them in with Malik and Lydia  
already waiting in the trauma room and immediately took control of the  
situation as attending physician.  
  
Pulling the gurney level with the Trauma room trolley, Mark called out  
"On my count, 1, 2, 3."  
  
In well rehearsed syncopation, the young boy was moved efficiently to  
the ER trolley, the paramedics quickly moving their gurney out of the  
Trauma room with their equipment to allow the ER staff to save the  
boy's life.  
  
"Two more units of saline" Doug instructed.  
  
Haleh took over bagging the boy as Doug and Mark conducted their own  
examinations. Carol connected the pulse ox monitor as Carter inserted  
IV's of Ringer's Lactate and D5 into the boy's arms.  
  
"CBC, H&H, Chem 7, coag panel, type and cross for six" Mark called  
out immediately.   
  
As Doug listened to the lungs, he knew there was a problem with the  
right lung, which the paramedic had disclosed on arrival.   
  
"5.5 ET tube" he directed as he moved to the head of the blond haired  
child. "Portable chest. CT spine, stan. head CT, pelvic and lower  
extremity films."  
  
Carol immediately has the tube ready for Doug to place down the boy's  
trachea. Haleh removed the bag as Doug removed the oral airway and   
quickly inserts the tube down the boy's trachea. Haleh had the ambu-  
bag ready and connected it to the tube.   
  
"BP's 60 palp, Pulse ox is 85" Malik informed them.  
  
Mark looked across at the boys trachea and noticed how it was being  
pushed to the left confirming his suspicions. "Tension pneumothorax.   
Give me a size 12 needle."   
  
Carol handed the needle to Mark. He quickly stabbed the needle into the  
boy's upper chest allowing the air to evacuate his chest. Making a small  
incision in the skin, Mark dissected down into the pleura cavity around  
the lung, passing the tube, which Carol placed into his hand, through the  
pleura into the chest cavity.  
  
"BP's 80 over 60 and rising." Malik reported.  
  
END PART 1/? 


End file.
